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Retinal Detachment

Topic Overview

What is retinal detachment?

The
retina is a thin membrane of nerve tissue that lines
the back of the
eye. When part or all of the retina comes off (detaches from) the back of the eye, it is called retinal detachment.

The nerve cells in
the retina normally detect light entering the eye and send signals to the brain
about what the eye sees. But when the retina detaches, it no longer works
correctly. It can cause blurred and lost vision. Retinal detachment requires
immediate medical care. If done soon enough, surgery can save lost
vision.

What causes retinal detachment?

Retinal detachment usually happens because there's a tear (hole) in the retina. The most common cause of a tear is posterior vitreous
detachment (PVD).
Vitreous gel fluid flows through the tear, pools beneath the retina, and lifts the retina off the back of the eye.

Retinal detachment can also happen without a retinal tear. Scar tissue buildup in the eye may pull on the retina. This is called traction. Or, fluid can build up under the retina for a different reason than a retinal tear.

Some of the reasons that make a person more likely to get a retinal detachment are an eye or head injury,
nearsightedness, eye disease, and diabetes.

What are the symptoms?

Many people
see floaters and flashes of light before they have symptoms of retinal detachment. Floaters are spots, specks, and
lines that float through your field of vision. Flashes are brief sparkles or
lightning streaks that are most easily seen when your eyes are closed. They
often appear at the edges of your visual field. Floaters and flashes do not
always mean that you will have a retinal detachment. But they may be a warning
sign, so it is best to be checked by a doctor right away.

Sometimes a retinal
detachment happens without warning. The first sign of detachment may be a
shadow across part of your vision that does not go away. Or you may have new
and sudden loss of side (peripheral) vision that gets worse over time.

How is retinal detachment diagnosed?

To diagnose
retinal detachment, your doctor will examine your eyes and ask you questions
about any symptoms you have.

If you have symptoms of retinal
detachment, your doctor will use a lighted magnifying tool called an
ophthalmoscope to examine your retina. With this tool, your doctor can see
holes, tears, or retinal detachment.

How is it treated?

Retinal detachment requires
care right away. Without treatment, vision loss can progress from minor to
severe or even to blindness within a few hours or days.

Surgery is
the only way to reattach the retina. In most cases, surgery can restore good
vision. There are many ways to do the surgery, such as using lasers, air bubbles, or a
freezing probe to seal a tear in the retina and reattach the retina.

Cause

Causes of retinal detachment are:

Tears or holes in the retina. These may lead to
retinal detachment by allowing fluid from the middle of the eye (vitreous gel) to collect
under the retina. A common cause of retinal tears is posterior vitreous detachment (PVD). An eye or head injury or other eye disorders,
such as lattice degeneration, a condition in which the retina becomes very
thin, may also cause tears or holes in the retina.

Traction on the retina. If tissue builds up between the vitreous gel and the retina, it can pull the retina
away from the back of the eye. The most common cause of this problem is
proliferative diabetic retinopathy, a condition that
leads to the growth of scar tissue that can pull on the retina.

Fluid buildup under the retina. Fluid buildup
under the retina can cause the retina to come off the back of the eye.
Fluid buildup may be caused by
inflammation or disease in the retina, in the layer just
beneath the retina (choroid), in blood vessels, or in tissues in the eye.

Symptoms

Most cases of
retinal detachment begin with a retinal tear. A retinal tear or another eye problem may cause:

Floaters in your field of vision. Floaters are thick
strands or clumps of solid vitreous gel that develop as the gel ages and breaks
down. Floaters often appear as dark specks, globs, strings, or dots. Floaters
may also be caused by loose blood or pigment from tears in the retina.

Flashes of light or sparks when you move your eyes or
head. These are easier to see against a dark background. The brief flashes
occur when the vitreous gel tugs on the retina (vitreous traction). These
flashes usually appear at the edge of your visual field.

Having floaters or flashes does not always mean that
you are about to have a retinal detachment, but you should not ignore these
symptoms. Call your doctor to discuss whether you need to have an eye exam.

If you have new or sudden flashes or floaters, darkness
over part of your visual field, or a new loss of vision that does not go away,
call your eye doctor or regular doctor right away. Floaters and
flashes may be warning signs of retinal detachment. A sudden shower of what
appear to be hundreds or thousands of little black dots across the field of
vision is a distinctive sign of blood and/or pigment in the vitreous gel and
may indicate a retinal detachment. This requires immediate medical
attention.

In rare cases, a retinal detachment can occur without warning. The first signs
may be:

A shadow or curtain effect across part of your
visual field that does not go away. Because detachments usually affect
peripheral (side) vision first, you may not notice a problem until the
detachment has gotten bigger.

New or sudden vision loss. Vision
loss caused by retinal detachment tends to get worse over time. Sudden vision loss is a medical emergency.

What Happens

Retinal detachment can progress quickly. Because retinal detachment affects side
(peripheral) vision first, you may not notice the vision loss right away. If
not treated, detachment can spread to the center of the retina (macula) and damage
central vision.

Retinal detachment requires urgent care. Without treatment, vision loss from retinal detachment
can progress from minor to severe or even to blindness within a few hours or
days.

Retinal tears and holes, though, may not need
treatment. The
retina sometimes develops small, round holes as it
ages, and many of them will not lead to retinal detachment. Retinal tears
caused by the
vitreous gel pulling on the retina (vitreous traction)
are more likely to cause retinal detachments.

Tears in the retina
caused by vitreous traction tend to cause flashes and floaters. A tear that
does not occur with vitreous traction and therefore develops without symptoms is far less likely to lead to a retinal
detachment than a tear that occurs with symptoms.

If the retina has detached, you will need surgery to reattach it and
restore vision. If you have had a retinal detachment in one eye, you have a
greater chance of developing one in the other eye.

What Increases Your Risk

Lattice degeneration, an inherited condition in which parts
of the retina become very thin and are easily torn.

Age older than
50.

Nearsightedness (myopia). The shape of a nearsighted
eye results in more pulling (traction) on the retina. This in turn can cause premature
posterior vitreous detachment. The retina is also thinner and more likely to
tear in people who are nearsighted.

Surgery for
cataracts. People who have had cataract surgery are at
increased risk for later developing retinal detachment.

When To Call a Doctor

Flashes of light and
floaters often occur as you get older or with
migraine headaches. Flashes of light in migraine
headaches are often located in the center of your visual field. But flashes of
light and floaters can also be signs of a problem that might lead to
retinal detachment.

If flashes of light
or floaters occur suddenly or in great numbers, or if you are not sure what to
do, do not wait for vision loss to occur before you call
your doctor. If you cannot reach your doctor, go to the emergency room. Although these symptoms do not cause pain and may seem
harmless, getting an eye exam and quick treatment can send you home relieved
or, if there is a problem, can save your vision.

Watchful waiting

Taking a wait-and-see approach, called watchful
waiting, is not an option if you have new or sudden flashes or floaters,
darkness over part of your visual field, or a new loss of vision that does not
go away. Sudden, rapid vision loss is a medical emergency.

Who to see

If you have symptoms that suggest that you might have
or are at immediate risk for a retinal detachment, call your doctor immediately. If you do not have an eye doctor (ophthalmologist), call your regular doctor. Based on
your symptoms, risk factors, and medical history, your doctor may refer you to
an eye doctor for an immediate exam and possible treatment.

Treatment for retinal tears and detachments is often done by an eye doctor who
specializes in retinal detachments.

Exams and Tests

To diagnose
retinal detachment, your doctor will ask you questions
about your symptoms, past eye problems, and risk factors. The doctor will also
test your near and distance vision (visual acuity) and side (peripheral)
vision. These routine vision tests do not detect retinal detachment, but they
can find problems that could lead to or result from retinal detachment.

A doctor can usually see a retinal tear or detachment while examining the
retina using
ophthalmoscopy. This test allows the doctor to see
inside the back of the eye using a magnifying instrument with a light.

If a retinal tear or detachment involves blood vessels in the retina, you
may have bleeding in the middle of the eye. In these cases, your doctor can
view the retina using
ultrasound, a test that uses sound waves to form an
image of the retina on a computer screen.

Early detection

It's important to have routine eye exams so that your eye doctor can look for retinal tears or other eye problems that could lead to retinal detachment. If you have a condition that puts you at high
risk for retinal detachment—such as nearsightedness, recent
cataract surgery,
diabetes, a
family history of retinal detachment, or a prior
retinal detachment in your other eye—talk to your doctor about having more frequent exams to detect
problems in their early stages.

If you notice
floaters or
flashes of light, let your doctor know about it right away. These symptoms could be a warning sign of a retinal tear that can
lead to detachment.

Treatment Overview

Retinal detachment requires care right away. Without treatment, vision loss can progress from minor to severe or even to blindness within a few hours or days.

Only surgery can repair
retinal detachment. It is usually successful and, in
many cases, restores good vision.

Prevention

You cannot prevent most cases of
retinal detachment. But having routine eye exams is important so that your eye doctor can look for signs that you might be more likely to have a retinal detachment.

Some eye injuries can
damage the
retina and cause detachment. You can reduce your risk
of these types of injuries if you:

Wear safety glasses when you use a hammer or
saw, work with power tools or yard tools such as weed eaters and lawn mowers,
or do any activity that might result in small objects flying into your
eye.

Wear special sports glasses or goggles during boxing,
racquetball, soccer, squash, and other sports in which you might receive a blow
to the eye.

Use appropriate safety measures when you use fireworks
or firearms.

Diabetes puts you at greater risk for developing
diabetic retinopathy, an eye disease that can lead to
tractional retinal detachment. If you have diabetes,
you can help control and prevent eye problems by having regular eye exams and
by keeping your blood sugar levels within a target range.

Treating a retinal tear can often prevent retinal detachment, but not all
tears need treatment. The decision to treat a tear depends on whether the tear
is likely to progress to a detachment.

Home Treatment

You cannot treat
retinal detachment at home. Surgery is the only
treatment.

After surgery to repair retinal detachment, your doctor
may give you specific instructions to help your eye recover. You may need to
rest and sleep with your head in a certain position, for example. And you may
be asked to wear an eye patch or use eyedrops.

Some types of
surgery to treat retinal detachments involve injecting a small bubble of gas
into the eye. Afterward, you may need to keep your head in a certain position for a few days or weeks, so that the gas bubble won't move. Also, you may need to avoid air travel until your eye
has healed and the bubble is gone, because the changes in air pressure may cause pain and affect your
eye.

If you have reduced vision after treatment, your eye doctor can help you learn ways to keep your independence and continue the activities you enjoy.

Surgery

Surgery for retinal detachment

Almost all retinal detachments can be repaired with
scleral buckle surgery, pneumatic retinopexy, or vitrectomy.

But even with such a high rate of success for
surgery, it is important to act quickly. The longer you wait to have surgery,
the lower the chances that good vision will be restored. When the retina loses
contact with its supporting layers, vision begins to get worse. An eye doctor
(ophthalmologist) who specializes in retinal
detachments will usually do surgery within a few days of your being
diagnosed with a detachment.

How soon you need surgery usually
depends on whether the retinal detachment has or could spread far enough to
affect
central vision. When the
macula, the part of the retina that provides central
vision, loses contact with the layer beneath it, it quickly loses its ability
to process what the eye sees.

Having surgery while the macula is still
attached will usually save vision.

If the macula has become
detached, surgery may occur a few days later than it would have otherwise. Good vision after surgery is still possible but less likely.

Your doctor will decide how soon you need surgery based
on the result of the retinal exam and the doctor's experience in treating
retinal detachment.

Surgery for retinal tears

Treating a retinal tear
may be useful if the tear is likely to lead to detachment. Symptoms such as
floaters or
flashing lights are key factors in deciding whether to
treat a tear. A tear that occurs right after a
posterior vitreous detachment (PVD) with symptoms is
usually much more dangerous and more likely to progress to a retinal detachment
than one that occurs without symptoms.

In deciding
when to treat a retinal tear, your doctor will
evaluate whether the torn retina is likely to detach. If the tear is very
likely to lead to detachment, treatment can usually repair it and prevent
detachment and potential vision loss. If the tear is not likely to lead to
detachment, you may not need treatment.

Surgery choices

Common methods of repairing a retinal detachment
include:

Pneumatic retinopexy. In this procedure, your eye
doctor injects a gas bubble into the middle of the eyeball. The gas bubble
floats to the detached area and lightly presses the detached retina to the wall of the eye. The eye doctor then
uses a freezing probe (cryopexy) or laser beam
(photocoagulation) to seal the tear in the
retina.

Scleral buckling surgery.
Your eye doctor places a piece of silicone sponge,
rubber, or semi-hard plastic on the outer layer of your eye and sews it in
place. This relieves pulling (traction) on the retina, preventing tears from getting
worse, and it supports the layers of the retina.

Vitrectomy. This is the removal of the
vitreous gel from the eye. Vitrectomy gives your eye
doctor better access to the retina and other tissues. It allows him or her to
peel scar tissue off the
retina, repair holes, close very large tears, and
directly flatten a retinal detachment.

Common methods of repairing a retinal tear
include:

Laser photocoagulation, in which an
intense beam of light travels through the eye and makes tiny burns around the
tear in the retina. The burns form scars that prevent fluid from getting under
the retina.

Cryopexy (freezing), in which your eye
doctor uses a probe to freeze and seal the retina around the tear.

What to think about

You have several surgical
options to repair a retinal detachment. Their success in restoring good vision
varies from case to case. The cause, location, and type of detachment usually
determine which surgery will work best. Other conditions or eye problems may
also play a role when you choose the best type of surgery.

You may
need more than one surgery to reattach the retina if scar tissue from the first surgery grows over the surface of your retina.

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